8/14/2019 1-4 APLAR,06- Gihan Omar

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Measurement of Bone Mineral Turnover in Patients with Rheumatoid Arthritis.

Gihan M. Omar1, Alan N Baer2and Jehan Abdel-wahab1.

1Department of rheumatology and rehabilitation, EL-Minia university, EL-Minia, Egypt

and 2Department of medicine, SUNY-at Buffalo, Buffalo, NY, USA.Bone demineralization is common in patients (pts) with rheumatoid arthritis (RA),particularly juxta-articular bone, which is likely due to stimulation of osteoclastic bone

resorption by cytokines produced by rheumatoid synovium. We sought to determine

whether biochemical measures of bone turnover would detect an increase in boneresorption in RA pts along with bone densitometric measurement, and whether treatment

with etanercept, an inhibitor of tumor necrosis factor, would significantly decrease bone

resorption. We measured bone mineral turnover in 13 pts with RA (10 female, 3 male).Mean age was 53 year (range, 27-72); seven women were postmenopausal. Mean disease

duration of RA was 11.8 years (range, 3-30), and rheumatoid factor was seropositive in

12 with high titers. Number of tender and swollen joints were 8.8 1.7 (mean SD) and

5.4 0.9, respectively. ACR functional class grade was represented in 61.5% and

steinbrocker grade in 46.6% pts. Measurement of bone resorption consisted of

24-hour urinary pyridionline (Pyd) and deoxypyridioline (Dpd) excretion. Boneformation was measured by serum bone-specific alkaline phosphatase (BSAP) and

procollagen peptide type (PICP). Urinary Pyd & Dpd levels were elevated in two men,

BSAP level was high in one of 13 pts and PICP levels were high in 2 premenopusal

women. Bone mineral density (BMD), measured by DEXA, was in the osteopenic range(T-score: -1.0 to -2.5 SD) in 5 women and 2 men in whom it was measured. Follow-up

measurements of bone turnover were obtained a median of 36 weeks (range, 18-53) after

the institution of etanercpt in 8 pts (6 female, 2 male). Improvement in disease activitywas noticed by means of shortening in morning stiffness time, lowering in number of

tender and swollen joints, significant lowering of CRP levels and by improvement of pts

wellbeing. BSAP levels increased in all pts, while PICP levels increased in only 6 pts.Urinary Pyd & Dpd levels were decreased in 5 of 8 pts and slightly elevated in 2 of 8 pts.

Although BMD was measured in 4 of 8 pts at one year interval from institution of the

drug, there has been a significant interval increase in axial BMD to stationary in the

different measured sites and a non significant interval decrease in BMD in 1 of 4 pts. Webelieve in the possible utility of bone turnover markers as a tool predicting bone loss in

RA pts and following institution of etanercept therapy.